Supplemental Health Literacy Items for

the CAHPS® Hospital Survey

Population Version: Adult

Language: English
These supplemental items were developed and tested together to address various issues
related to patients’ health literacy in hospital settings. Learn more about the CAHPS® Health
Literacy Item Sets.

Use with HCAHPS: The items were designed to be added to the Adult version of HCAHPS,
which is implemented nationally by the Centers for Medicare & Medicaid Services (CMS).
While users of HCAHPS are free to incorporate supplemental items in order to meet the needs
of their organizations, local markets, and/or audiences, the use of these supplemental items is
not part of the national implementation requirements. Additionally, some items cover events
that occur with low frequency in the general population. You should include them only if your
sample design is likely to yield a sufficient number of responses to those questions for
statistical analysis and reporting.

To learn more about HCAHPS and its implementation by CMS, visit www.hcahpsonline.org.

Important instructions regarding the placement of supplemental items in the core

questionnaire: Under CMS’s rules for national implementation of HCAHPS, you must place all
supplemental items before the “About You” section of the survey.

 After the last item before the “About You” section, begin a new page and add the
following text (bolded):
Now we would like to gather some additional detail on topics we have
asked you about before.
 Add new subheadings as instructed in the table below. The need for a subheading
depends on which questions you choose to use.
 Format the subheading so that it is consistent with existing subheadings.

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL1. During this hospital stay, did hospital staff ask you to Note: Before items H-HL1 –
describe how you were going to take your medications H-HL2, add a new
when you were at home? subheading: “Information
About Medications”
1
Yes
2
No Note: Add a new instruction
before H-HL1: “If you were
not given any medication
when you left the hospital,
go to Question X.” Replace
X with the number used for
H-HL3, or the next question
in your survey.
H-HL2. During this hospital stay, did hospital staff tell you who to After H-HL1
call if you had questions about your medications?
1
Yes
2
No
H-HL3. During this hospital stay, how often were nurses hard to After H-HL2
understand because of the way they spoke your language?
Note: Before items H-HL3 –
1
Never H-HL9, add a new
2
Sometimes subheading: “Talking With
3
Usually Nurses”
4
Always
H-HL4. During this hospital stay, how often did nurses use medical After H-HL3
words you did not understand?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL5. During this hospital stay, how often did nurses talk too fast After H-HL4
when talking with you?
1
Never
2
Sometimes
3
Usually
4
Always

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL6. During this hospital stay, how often did nurses interrupt you After H-HL5
when you were talking?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL7. During this hospital stay, how often did nurses answer all After H-HL6
your questions to your satisfaction?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL8. During this hospital stay, how often did nurses use a After H-HL7
condescending, sarcastic, or rude tone or manner with you?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL9. During this hospital stay, how often did you feel nurses After H-HL8
really cared about you as a person?
Never
1

Sometimes
2

3
Usually
4
Always
H-HL10. During this hospital stay, how often were doctors hard to After H-HL9
understand because of the way they spoke your language?
Note: Before items H-HL10 –
Never
1
H-HL18, add a new
2
Sometimes subheading: “Talking With
3
Usually Doctors”
4
Always
H-HL11. During this hospital stay, how often did doctors use medical After H-HL10
words you did not understand?
1
Never
2
Sometimes
3
Usually
4
Always

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL12. During this hospital stay, how often did doctors talk too fast After H-HL11
when talking with you?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL13. During this hospital stay, how often did doctors use After H-HL12
pictures, drawings, models, or videos to explain things to
you?
Never
1

Sometimes
2

3
Usually
4
Always
H-HL14. During this hospital stay, how often did doctors interrupt After H-HL13
you when you were talking?
Never
1

Sometimes
2

3
Usually
4
Always
H-HL15. During this hospital stay, how often did doctors answer all After H-HL14
your questions to your satisfaction?
Never
1

Sometimes
2

3
Usually
4
Always
H-HL16. During this hospital stay, how often did doctors make sure After H-HL15
you understood all the information you were given?
Never
1

Sometimes
2

3
Usually
4
Always
H-HL17. During this hospital stay, how often did doctors use a After H-HL16
condescending, sarcastic, or rude tone or manner with you?
1
Never
2
Sometimes
3
Usually
4
Always

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL18. During this hospital stay, how often did you feel doctors After H-HL17
really cared about you as a person?
1
Never
2
Sometimes
3
Usually
4
Always
H-HL19. During this hospital stay, did you have a blood test, x-ray, or After H-HL18
other test?
Note: Before items H-HL19 –
1
Yes H-HL23, add a new
2
No  If No, go to H-HL24 subheading: “Talking About
Tests”
H-HL20. During this hospital stay, before you had a blood test, x-ray, After H-HL19
or other test, how often did hospital staff explain what it was
for? Note: Use with H-HL19
1
Never  If Never, go to H-HL22
2
Sometimes
3
Usually
4
Always
H-HL21. How often was the explanation of what the test was for easy After H-HL20
to understand?
Note: Use with H-HL20
1
Never
2
Sometimes
3
Usually
4
Always
H-HL22. During this hospital stay, when you had a blood test, x-ray, After H-HL21
or other test, how often did hospital staff explain the results
to you? Note: Use with H-HL19
Never  If Never, go to H-HL24
1

Sometimes
2

3
Usually
4
Always
H-HL23. How often were the results of your blood test, x-ray, or After H-HL22
other test easy to understand?
Note: Use with H-HL22
1
Never
2
Sometimes
3
Usually
4
Always

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL24. During this hospital stay, did you have to sign any forms? After H-HL23
1
Yes Note: Before items H-HL24 –
2
No  If No, go to H-HL26 H-HL31, add a new
subheading:
“Communication About
Forms”
H-HL25. During this hospital stay, how often did hospital staff After H-HL24
explain the purpose of a form before you signed it?
Note: Use with H-HL24
Never
1

2
Sometimes
3
Usually
4
Always
H-HL26. During this hospital stay, did you have to fill out any forms? After H-HL25
Yes
1

No  If No, go to H-HL32

2

H-HL27. During this hospital stay, how often did hospital staff offer After H-HL26
you help to fill out a form?
Note: Use with H-HL26
1
Never
2
Sometimes
3
Usually
4
Always
H-HL28. During this hospital stay, how often were the forms easy to After H-HL27
fill out?
Note: Use with H-HL26
1
Never
2
Sometimes
3
Usually
4
Always
H-HL29. During this hospital stay, how often were you given enough After H-HL28
time to fill out forms?
Note: Use with H-HL26
1
Never
2
Sometimes
3
Usually
4
Always

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL30. During this hospital stay, did you ever need forms in a After H-HL29
language other than English?
Note: Use with H-HL26
Yes
1

2
No  If No, go to H-HL32
H-HL31. During this hospital stay, how often were the forms that you After H-HL30
had to fill out or sign available in your language?
Note: Use with H-HL30
Never
1

2
Sometimes
3
Usually
4
Always
H-HL32. After you left the hospital, did you go directly to your own After H-HL31
home, to someone else’s home, or to another health facility?
Note: Before items H-HL32 –
1
Own home H-HL39, add a new
2
Someone else’s home subheading: “Information
2
Another health facility  If Another, go to core About How to Care for
question 26 Yourself”

Note: H-HL32 repeats

question 18 in the Adult
HCAHPS Survey in order to
set up the subsequent
questions. Add the following
instruction before H-HL32:
“We need you to answer the
following question again
although you have already
answered it in the first part
of the survey.”
H-HL33. During this hospital stay, did hospital staff give you a After H-HL32
telephone number to call if you had problems after you left
the hospital? Note: Use with H-HL32
1
Yes
2
No

H-HL34. During this hospital stay, did hospital staff tell you how to After H-HL33
take care of yourself at home?
Note: Use with H-HL32
1
Yes
2
No  If No, go to H-HL36

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CAHPS® Hospital Survey Supplemental Items: Health Literacy
Population Version: Adult

Placement and Other

Questions Instructions
H-HL35. Was this information about how to take care of yourself at After H-HL34
home easy to understand?
Note: Use with H-HL34
Yes
1

2
No
H-HL36. During this hospital stay, did you get instructions in writing After H-HL35
about how to take care of yourself at home?
Note: Use with H-HL32
Yes
1

2
No  If No, go to core question 26
H-HL37. Were the written instructions about how to take care of After H-HL36
yourself at home easy to understand?
Note: Use with H-HL36
Yes
1

2
No
H-HL38. Did you need written instructions about how to take care of After H-HL37
yourself at home in a language other than English?
Note: Use with H-HL32
Yes
1

2
No  If No, go to core question 26
H-HL39. Were the written instructions about how to take care of After H-HL38
yourself at home available in your language?
Note: Use with H-HL38
1
Yes
2
No

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